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Posts for: February, 2014

A callus is an area of the skin with an excess buildup of keratinocytes (cells that produce the keratin which makes up the outer layer of skin).  The cells proliferate in response to any excess in pressure or friction.  This is your body's natural protective response traumatic stimuli.  The most common places for calluses to form are the hands and the feet.  I commonly get a callus buildup on my hands when doing pulling exercises at the gym.  This can get irritating which is why many heavy lifters use chalk or lifting gloves.

The feet are also a very common place for callus formation.  The average active adult will walk over 5000 steps a day which equates to over 2 miles.  Every step puts your entire body weight and momentum onto your shoes which in turn transfers that pressure to your feet.  That's a lot of pressure and friction every single day.  The feet are built to handle this pressure and for most people it's not a problem.  However, many people get a buildup of calluses.  For the trained eye, these calluses are obvious patterns of wear that indicate problem areas in the foot.  Common places for callus formation are the heel, metatarsal heads (the balls of your feet), side of the big toe, and on top of the toes. 

Without getting too technical, let's just say that the foot has more going on biomechanically than any other location in your body.  With 26 bones in each foot interacting with each other at 33 joints it doesn't take much to throw the system out of wack.  The purpose of these joints is to absorb the body weight and propel you along while expending the least amount of energy possible.  Your body is remarkably efficient at locomotion. 

So what can throw the system out of wack?

·         Wearing shoes that interfere with normal motion or don't properly distribute the weight

·         Variations in foot structure that can predispose to abnormal weight distribution

·         rapid weight gain that puts more stress on the foot than it can handle

·         Trauma that alters growth at a young age

·         Anything that causes pronation

·         Arthritis, pain, or injury which may cause you to alter your gait to alleviate the pain

The list can go on but you get the idea.  When you visit your podiatrist, you can bet he'll be looking at your calluses for clues as to what may be happening with your foot.  In many cases the reason for callus formation is benign such as a recent change in shoes or increase in activity.  In other cases, orthotics may be able to relieve the callus formation and correct a biomechanical abnormality. 

If you are curious as to why you have recurrent callus formation, then I encourage you to make an appointment with your local podiatrist at Affiliated Foot and Ankle Care located in Edison and Monroe NJ today.  Have a great day and remember to take care of your feet!

By Nrupa Shah


Fungal nails are a plague that you can't get rid of.  They can cause your nails to become yellow, brown, and/or black and have you thinking twice before you hit the beach with sandals when it finally warms up.  I would like to tell you about my approach to a fungal nail infection.

When a patient walks into the podiatry office with a high suspicion of fungal infection, the first thing to do is take a biopsy.  This generally involves cutting away some nail pieces to send to the pathologist.  The pathologist will inspect the nail tissue for signs of infection and use a special stain to visualize the fungal organisms.  After the biopsy I will trim the nail and clean it up and send the patient home to return in about a week.

If, and when the pathology report comes back positive for fungus, it’s time to consider treatment options. Let's assume we have a relatively healthy patient that wants to be able to wear sandals.  There are basically two options that I present the patient with.  If only one nail is infected (most commonly the big toe) then I present the patient with the option to remove the nail completely.  This is a simple 5-10 minute procedure that requires anesthesia of the toe and some sterile instrumentation to remove the entire nail.  The patient will be put on an oral antifungal agent to ensure no fungus survives and the nail will grow back clean and normal.  This treatment is aggressive but offers the greatest chance of full nail recovery.

The second option is to leave the infected nail intact and try to treat the infection with lasers, creams, or oral antifungal agents.  Lasers and topical creams can work to kill the organism within the nail but should be stacked with an oral antifungal agent that works to kill the fungal organisms on a systemic level.  This option can also result in a clean and normal looking nail in some cases.  If the fungal infection has been present for years or even decades then a full recovery is very difficult or impossible to achieve. 

Oral antifungal agents such as terbinafine have been the gold standard treatment for fungal nails and every treatment regimen should include this medication.  Even with this medication, there are some nails that will never return to normal.  If you have nails that have recently started to change color or become brittle and oddly shaped then you may have a fungal infection and you have the best chance for recovery if you treat it immediately.  Remember, your local podiatrist sees patients with fungal infections on a daily basis. 

If you have any questions about your shoe gear, feet, or nails, make an appointment with your local podiatrist at Affiliated Foot and Ankle Care located in Edison and Monroe NJ today.

By Varun Gujral

 


Yellow, possibly fungal, nails are one of the most common complaints that show up at a podiatry office.  There are many misconceptions about fungal nails and I'd like to take you on a quick tour of my approach to ugly, yellow, and often dystrophic nails. 

First of all, many patients come in complaining of a fungal infection because their toenails look yellow, chunky, or like they're about to fall off.  The misnomer is that all yellow nails are infected which is often not the case.  The most common cause of yellow dystrophic nails is actually what we call micro trauma.

Micro Trauma to the nail unit is repetitive banging or force on the nail.  This repetitive trauma to the nail will over time cause a callus to form under the nail.  Normally when your skin forms a callus the excess skin will eventually be sloughed off.  When the callus is under the nail the skin is stuck and pushes up on the nail.  This excess skin tissue is what causes the nail to appear yellow and often raises the nail unit up eventually causing the nail to fall off. 

So, when a young patient comes in that has recently started training for a marathon, my mind is thinking micro trauma, not infection.  The micro trauma generally occurs in athletes, especially runners with tight shoes that don't allow enough space for the toes to slide forward upon impact.  Instead the toes are slamming into the forward aspect of the shoe, causing damage.  So, I tell my runners to bring in their shoes so I can take a look and see if they are fitting correctly.  If they have micro trauma then nine times out of ten their shoes are too small. 

The second half of the story is unfortunately, fungus.

Remember that callus which formed under the nail?  Well that callus is mostly keratin, the main component of skin.  Anyone want to guess what fungal organisms like T. Rubrum like to feed on? That's right, keratin.  The micro trauma will cause your nails to become yellow and ugly and can also provide a nice cozy home for fungal organisms to thrive in.  Once that fungus gets in there, it can be very difficult to get rid of.

If you have any questions about your shoe gear, feet, or nails, make an appointment with your local podiatrist at Affiliated Foot and Ankle Care in Edison and Monroe NJ today.

By Nrupa Shah